What should I do about pus from my umbilicus (navel) after taking Doxycycline (Doxycycline) for a black eschar on my hand?

Umbilical Infection Requiring Urgent Medical Evaluation

You need immediate in-person medical evaluation for purulent umbilical discharge, as this represents omphalitis (umbilical infection) that requires incision and drainage plus antibiotics, and may indicate an underlying anatomical abnormality such as a urachal remnant or omphalomesenteric duct remnant.

Immediate Actions Required

Seek urgent medical care today - purulent discharge from the umbilicus in an adult is not normal and requires:

• Incision and drainage of any abscess present 1
• Imaging with ultrasound or CT scan to evaluate for underlying anatomical abnormalities like urachal remnants or omphalomesenteric duct remnants 2, 3
• Antibiotic therapy targeting skin flora (typically staphylococci and streptococci) 1, 2

Why This Is Serious

The umbilicus harbors dense bacterial colonization that is difficult to eradicate even with antiseptics 4, 5. When infection develops with purulent discharge:

• Adult omphalitis is rare and often indicates an underlying structural problem - such as infected urachal remnants connecting the umbilicus to the bladder 2, 3
• Surgical exploration may be necessary if imaging reveals anatomical abnormalities 3
• The infection can progress to surrounding soft tissue infection or systemic sepsis if untreated 1

Relationship to Your Recent Doxycycline Use

The doxycycline you took for the black eschar on your hand is unlikely to be the direct cause of your umbilical infection, though there are important considerations:

• The black eschar suggests you may have had a serious infection (potentially Lyme disease, anthrax, or necrotizing infection) that required doxycycline 6
• If you have an underlying immunocompromising condition that caused the eschar, this could predispose you to the umbilical infection 1
• Doxycycline itself does not typically cause umbilical infections

What Your Doctor Will Likely Do

Clinical Examination

• Assess for erythema, edema, tenderness, and purulent discharge from the umbilicus 2
• Evaluate for surrounding cellulitis or systemic signs of infection (fever, tachycardia) 1
• Perform digital examination if deeper infection suspected 1

Diagnostic Testing

• Culture the purulent discharge before starting antibiotics 1
• Ultrasound or CT imaging to identify urachal remnants, omphalomesenteric duct remnants, or abscess collections 2, 3
• Blood work if systemic infection suspected 1

Treatment Approach

For localized umbilical abscess:

• Incision and drainage is the primary treatment 1
• Antibiotics covering MRSA and streptococci: options include doxycycline, clindamycin, or trimethoprim-sulfamethoxazole for 7 days 1
• Vancomycin or linezolid if severe infection or systemic signs present 1

If anatomical abnormality found:

• Surgical excision of the urachal or omphalomesenteric remnant is mandatory after initial infection control 3
• The lesion should be excised en bloc with part of the bladder or bowel if connected 3

Critical Warning Signs

Seek emergency care immediately if you develop:

• Fever, chills, or feeling systemically unwell 1
• Spreading redness beyond 2 cm from the umbilicus 1
• Skin sloughing, bullae, or rapidly worsening appearance 1
• Hypotension or confusion 1

Common Pitfall to Avoid

Do not attempt to treat this with topical antibiotics alone - umbilical infections in adults require drainage and systemic antibiotics, and topical antibiotic ointments are specifically not recommended for umbilical infections as they can promote fungal superinfection 1.